Michaelia Cucci, BCCCP, BCPS, PharmD
Clinical Pharmacy Specialist- Surgical/Trauma ICU
Cleveland Clinic Akron General
Akron, Ohio
Disclosure information not submitted.
Brittany Cunningham, BCCCP, BCPS, PharmD
Clinical Pharmacy Specialist - Neuroscience ICU
Cleveland Clinic Akron General, United States
Disclosure information not submitted.
Christopher Newey, DO, MS, FNCS
Medical Director, Neurosciences Intensive Care Unit
Cleveland Clinic Akron General, United States
Disclosure information not submitted.
Scott Benken, BCPS, PharmD
Pharm D
University of Illinois Health Sciences and Medical Center
Chicago, Illinois
Disclosure information not submitted.
Chanda Mullen, PhD
Research Coordinator
Cleveland Clinic Akron General, United States
Disclosure information not submitted.
Title: Evaluation of blood pressure variability in moderate to severe traumatic brain injuries
INTRODUCTION/HYPOTHESIS: Traumatic brain injuries (TBI) result in significant morbidity and mortality annually. Clinical practice guidelines recommend prevention of secondary injury by avoidance of hypotension; however, it is unknown if blood pressure variability (BPV) would have effects on clinical outcomes. The aim of this study is to evaluate whether increased BPV is associated with unfavorable Glasgow Outcome Scale (GOS) scores in patients with moderate to severe TBIs.
Methods: This study is a retrospective, cohort study of adult trauma ICU patients admitted to a level 1 trauma center with moderate to severe TBIs (head Abbreviated Injury Scale (AIS) >1, Glasgow Coma Scale (GCS) 3-12) from 1/1/2018 to 5/31/2020. Patients were excluded for anoxic and penetrating brain injuries and severe alcohol withdrawal. Group assignment was favorable (GOS 4-5) vs. unfavorable (GOS 1-3) GOS scores at discharge. The GOS was adjudicated by least two independent, blinded reviewers. The SBP was obtained from all BP readings in the initial 72 hours obtained on at least hourly. The primary outcome measure was the standard deviation (SD) of systolic blood pressure (SBP) and the coefficient of variance (CV) of SBP was also measured. The SD-SBP was computed by variance from the mean and CV-SBP by the SD divided by the mean. A generalized linear model was performed to test the association with the SD-SBP and the GOS.
Results: Of the 608 patients eligible for inclusion, 89 patients were included with 50 (56%) and 39 (44%) in the unfavorable and favorable groups, respectively. The study population had a mean age of 59 (SD 21), 65% male, median head AIS of 4 [IQR 3-5] and GCS of 6 [IQR 3-10], primarily subdural (n=54, 61%) and subarachnoid (n=48, 54%) hemorrhages, and 42 (47%) required surgical intervention. There was no significant difference between the mean SBP readings (125 vs. 123 mmHg, p=0.377), SD-SBP (16.8 vs. 18.2, p=0.236), or CV-SBP (0.13 vs. 0.15, p=0.104) between the favorable and unfavorable groups. Based on a generalized linear model, there was no association of SD-SBP (estimate -0.03, p=0.213) or CV-SBP (estimate -0.04, p=0.173) with the GOS.
Conclusions: Blood pressure variability measured by SD-SBP or CV-SBP may not be associated with an unfavorable outcome in patients with moderate to severe TBI.